Provider Demographics
NPI:1922157445
Name:ANTTILA, PATRICIA (PT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:ANTTILA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:KAPALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:270B COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:PORTOLA
Mailing Address - State:CA
Mailing Address - Zip Code:96122-9608
Mailing Address - Country:US
Mailing Address - Phone:530-832-9642
Mailing Address - Fax:530-832-9643
Practice Address - Street 1:270 COMMERCIAL ST
Practice Address - Street 2:B
Practice Address - City:PORTOLA
Practice Address - State:CA
Practice Address - Zip Code:96122-9608
Practice Address - Country:US
Practice Address - Phone:530-832-9642
Practice Address - Fax:530-832-9643
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20786174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00046838Medicaid
CA0PT207860OtherBLUE SHIELD
CAP35240Medicare UPIN
CA0PT207860OtherBLUE SHIELD